The Health Roundtable

Instant bedside review of mobile CXR’s using Direct Capture Mobile X-Ray

Presenter: Ryan Midgley

Hospital Code Name: Royal Adelaide Hospital

Innovation Poster SessionHRT1215 – Innovation AwardsSydney 11th and 12th Oct 2012

The Health Roundtable

KEY PROBLEM

The issue was time delay for a diagnosis of acute chest pathology and confirmation of line positions for doctors, and the best use of staff for mobile examinations.

The Health Roundtable

AIM OF THIS INNOVATION

Improvement Sought was to decrease the time delay to review mobile x-rays, and to give a more efficient service by better managing radiographers time.

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BASELINE DATA

Our old system of imaging using Computed Radiography takes approx 20 min from taking the x-ray to view and image. With DR the requesting doctor can view an image instantaneously (at the bedside). Most of all we can image multiple patients one after the other without returning to the department and processing images. The 2 Graphs below demonstrate the time to view a single x-ray and then the time to view an image when 3 patients are x-rayed without returning to the department.

Delay to view Image

0

10

20

30

40

50

60

70

CR DR CR 3 PATIENTS DR 3 PATIENTS

Modality/patient

Tim

e M

inu

tes

Series1

This Graph shows that no matter how many patients are imaged DR ensures no delay for the referrer to view images, however CR has at minimum a 15 minute delay

The Health Roundtable

KEY CHANGES IMPLEMENTED

Purchase of a DR mobile – Key change Introduction of Electronic Ordering – Streamline

workload management - OACIS Use of Text Messaging paging service – Ability to

inform radiographers of patients details requiring Mobile examinations while on ward without returning to department

Dr is requested to be on the ward when we do the mobile

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OUTCOMES SO FAR Image review is now possible at patients bedside as soon as the image

is taken No delay for doctors when looking at lines eg, NGT, ET, PICC –

Decreased time to administer medication, feeds. Lines able to be re positioned if required and a follow up x-ray can be

taken immediately without the radiographer returning to the department

If image is of sub optimal standard x-ray can be repeated immediately without returning to the department then back to patients bedside to re x-ray – 100% increase in productivity

No need for radiographers to return to the department between x-rays eliminating delay to image multiple patients

Better Image quality higher resolution with outstanding image quality – More diagnostic images

Ability to halve exposures – decrease in dose to patient and staff, Have decreased the Number of Mobile machines in the department

from 5 to 3 due to the increase in efficiency $100K/5yr DR Mobile is now expected by clinicians on the ward!!

The Health Roundtable

LESSONS LEARNT Purchase of a lighter wireless DR mobile – Corded

systems are bad for infection control purposes and earlier detectors are heavy

Ability to retrofit existing Machines now possible – Make use of existing analogue equipment

Use of text paging service if available is extremely efficient as is the use of a portable phone

When Radiographer heads off to the ward make sure Dr requesting will be there to review image, saves radiographer waiting for Dr to view images

If possible wireless RIS and PACS would allow for instant upload and downloads of images and work list to PACS for radiologist review.